@article{8612063,
  abstract     = {{Aims Reducing maternal mortality is a World Health Organization (WHO) global health goal. Although maternal deaths due to haemorrhage and infection are declining, those related to heart disease are increasing and are now the most important cause in western countries. The aim is to define contemporary diagnosis-specific outcomes in pregnant women with heart disease.

Methods and results From 2007 to 2018, pregnant women with heart disease were prospectively enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC). Primary outcome was maternal mortality or heart failure, secondary outcomes were other cardiac, obstetric, and foetal complications. We enrolled 5739 pregnancies; the mean age was 29.5. Prevalent diagnoses were congenital (57%) and valvular heart disease (29%). Mortality (overall 0.6%) was highest in the pulmonary arterial hypertension (PAH) group (9%). Heart failure occurred in 11%, arrhythmias in 2%. Delivery was by Caesarean section in 44%. Obstetric and foetal complications occurred in 17% and 21%, respectively. The number of high-risk pregnancies (mWHO Class IV) increased from 0.7% in 2007-2010 to 10.9% in 2015-2018. Determinants for maternal complications were pre-pregnancy heart failure or New York Heart Association >II, systemic ejection fraction <40%, mWHO Class 4, and anticoagulants use. After an increase from 2007 to 2009, complication rates fell from 13.2% in 2010 to 9.3% in 2017.

Conclusion Rates of maternal mortality or heart failure were high in women with heart disease. However, from 2010, these rates declined despite the inclusion of more high-risk pregnancies. Highest complication rates occurred in women with PAH.}},
  author       = {{Roos-Hesselink, Jolien and Baris, Lucia and Johnson, Mark and De Backer, Julie and Otto, Catherine and Marelli, Ariane and Jondeau, Guillaume and Budts, Werner and Grewal, Jasmine and Sliwa, Karen and Parsonage, William and Maggioni, Aldo P and van Hagen, Iris and Vahanian, Alec and Tavazzi, Luigi and Elkayam, Uri and Boersma, Eric and Hall, Roger}},
  issn         = {{0195-668X}},
  journal      = {{EUROPEAN HEART JOURNAL}},
  keywords     = {{Pregnancy,Maternal mortality,Congenital Heart Disease,Cardiomyopathies,Pregnancy complications,PULMONARY ARTERIAL-HYPERTENSION,EUROPEAN-SOCIETY,MATERNAL MORTALITY,HEART-DISEASE,MANAGEMENT,RISK}},
  language     = {{eng}},
  number       = {{47}},
  pages        = {{3848--3855}},
  title        = {{Pregnancy outcomes in women with cardiovascular disease : evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC)}},
  url          = {{http://doi.org/10.1093/eurheartj/ehz136}},
  volume       = {{40}},
  year         = {{2019}},
}

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